eMedinewS11th February 2014, Tuesday

Dr K K AggarwalPadma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal

President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Editor in Chief IJCP Group, National Vice President Elect, Indian Medical Association; Chairman Ethical Committee Delhi Medical Council, Hony. Visiting Professor (Clinical Research) DIPSAR; Chairman (Delhi Chapter) International Medical Sciences Academy (March 10–13); Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04);
For updates follow at
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Top 100 Selling Drugs of 2013

Hypothyroid medication levothyroxine (Synthroid, AbbVie) was the nation's most prescribed drug in 2013, whereas the antipsychotic aripiprazole (Abilify, Otsuka Pharmaceutical) had the highest sales, at nearly $6.5 billion. Following levothyroxine as the most prescribed were the cholesterol-lowering drug rosuvastatin (Crestor, AstraZeneca), the proton-pump inhibitor esomeprazole (Nexium, AstraZeneca), and the antidepressant duloxetine (Cymbalta, Eli Lilly).

Rounding out the top 10 most prescribed drugs in 2013 (in order) were the asthma drugs albuterol (Ventolin, HFA) and fluticasone propionate/salmeterol (Advair Diskus, GlaxoSmithKline), the antihypertensive valsartan (Diovan, Novartis), the attention deficit drug lisdexamfetamine dimesylate (Vyvanse, Shire), the antiepileptic pregabalin (Lyrica, Pfizer), and the chronic obstructive pulmonary disease drug tiotropium bromide (Spiriva, Boehringer Ingelheim).

After aripiprazole, the next best selling drugs in 2013 were Nexium, at $6.1 billion, and the arthritis drug adalimumab (Humira, AbbVie), at $5.5 billion.

Rounding out the top 10 in sales were Crestor ($5.3 billion), Cymbalta ($5.2), Advair Diskus ($5.1 billion), the arthritis drugs etanercept (Enbrel, Amgen; $4.6 billion) and infliximab (Remicade, Centocor; $4.1 billion), the multiple sclerosis drug glatiramer acetate (Copaxone, Teva Pharm; $3.7 billion), and neutropenia drug pegfilgrastim (Neulasta, Amgen; $3.6 billion).

Table 1. Top 100 Drugs by Sales
Rank Drug Brand Chemical Name Sales, 2013
1 Abilify Aripiprazole $6,460,215,394
2 Nexium Esomeprazole $6,135,667,614
3 Humira Adalimumab $5,549,996,855
4 Crestor Rosuvastatin calcium $5,310,818,889
5 Cymbalta Duloxetine hydrochloride $5,219,860,418
6 Advair Diskus Fluticasone propionate $5,121,312,668
7 Enbrel Etanercept $4,681,201,645
8 Remicade Infliximab $4,098,233,242
9 Copaxone Glatiramer acetate $3,697,182,238
10 Neulasta Pegfilgrastim $3,580,364,758
11 Rituxan Rituximab $3,288,614,045
12 Lantus Solostar Insulin Glargine $3,005,681,663
13 Spiriva Handihaler Tiotropium bromide $2,998,207,542
14 Atripla (Efavirenz/emtricitabine/tenofovir disoproxil fumarate) Combination Tablet $2,856,818,557
15 Januvia Sitagliptin $2,843,496,907
16 Avastin Bevacizumab $2,688,414,938
17 Lantus Insulin Glargine $2,556,825,619
18 Oxycontin Oxycodone HCl $2,534,909,675
19 Lyrica Pregabalin $2,415,254,835
20 Epogen Epoetin Alfa $2,280,696,834
21 Celebrex Celecoxib $2,237,658,764
22 Truvada Emtricitabine/tenofovir disoproxil fumarate $2,235,712,145
23 Diovan Valsartan $2,169,819,482
24 Herceptin Trastuzumab $1,938,804,857
25 Gleevec Imatinib Mesylate $1,896,982,614
26 Lucentis Ranibizumab $1,859,463,484
27 Namenda Memantine HCL $1,856,822,750
28 Vyvanse Lisdexamfetamine dimesylate $1,743,115,521
29 Zetia Ezetimibe $1,710,526,476
30 Symbicort Budesonide and formoterol $1,563,242,161
31 Levemir Insulin Detemir $1,547,629,745
32 Suboxone Buprenorphine and naloxone $1,450,554,130
33 Novolog Flexpen Insulin aspart $1,377,221,614
34 Novolog Insulin aspart $1,349,403,122
35 Avonex Interferon beta–1a $1,240,754,136
36 Seroquel Xr Quetiapine fumarate $1,226,532,019
37 Viagra Sildenafil citrate $1,196,812,385
38 Alimta Pemetrexed $1,192,134,813
39 Humalog Insulin Lispro (Human Analog) $1,184,189,487
40 Nasonex Mometasone furoate monohydrate $1,137,402,455
41 Victoza 3–Pak Liraglutide $1,104,811,637
42 Cialis Tadalafil $1,086,355,583
43 Gilenya Fingolimod Capsules $1,059,346,323
44 Flovent Hfa Fluticasone Propionate HFA $1,050,009,900
45 Procrit Epoetin alfa $1,030,419,958
46 Isentress Raltegravir $1,014,678,055
47 Xarelto Rivaroxaban $996,441,091
48 Prezista Darunavir $992,087,940
49 Janumet Sitagliptin Metformin HCL $987,663,598
50 Stelara Ustekinumab $965,072,892
51 Neupogen Filgrastim $958,807,372
52 Orencia Abatacept $957,680,500
53 Renvela Sevelamer Carbonate $955,330,199
54 Reyataz Atazanavir sulfate $934,879,388
55 Vesicare Solifenacin $933,311,254
56 Dexilant Dexlansoprazole $916,401,204
57 Tecfidera Dimethyl fumarate $879,673,483
58 Humalog Kwikpen Insulin lispro injection $879,632,962
59 Synthroid Levothyroxine Sodium $858,725,708
60 Vytorin Ezetimibe and Simvastatin $858,576,112
61 Lunesta Eszopiclone $851,791,226
62 Pradaxa Dabigatran Etexilate Mesylate $836,573,805
63 Benicar Olmesartan Medoxomil $832,276,970
64 Evista Raloxifene $823,647,433
65 Xolair Omalizumab $821,783,471
66 Aranesp Darbepoetin Alfa $809,245,700
67 Prevnar 13 Pneumococcal vaccine 13–valent $806,129,346
68 Sensipar Cinacalcet $786,320,942
69 Xgeva Denosumab $785,725,436
70 Invega Sustenna Paliperidone palmitate $779,834,172
71 Zytiga Abiraterone Acetate $775,269,249
72 Avonex Pen Interferon beta–1a $768,655,140
73 Synagis Palivizumab $767,786,422
74 Betaseron Interferon beta–1 $767,648,290
75 Xeloda Capecitabine $754,133,787
76 Ventolin Hfa Albuterol sulfate $745,629,470
77 Zyvox Linezolid $726,184,205
78 Afinitor Everolimus $721,629,719
79 Gardasil Human Papillomavirus Quadrivalent $710,208,856
80 Zostavax Zoster vaccine live $705,140,729
81 Incivek Telaprevir $701,317,408
82 Sandostatin Lar Octreotide Acetate $697,961,265
83 Aciphex Rabeprazole Sodium $683,359,951
84 Benicar Hct Olmesartan Medoxomil-Hydrochlorothiazide $681,353,719
85 Bystolic Nebivolol $681,318,227
86 Treanda Bendamustine Hydrochloride $679,052,250
87 Focalin Xr Dexmethylphenidate Hydrochloride $660,161,202
88 Erbitux Cetuximab $648,984,405
89 Tamiflu Oseltamivir phosphate $641,134,799
90 Tarceva Erlotinib $640,597,157
91 Pristiq Desvenlafaxine $632,619,542
92 Complera Emtricitabine/Rilpivirine/Tenofovir Disoproxil Fumarate $630,039,312
93 Cubicin Daptomycin $628,034,439
94 Velcade Bortezomib $621,800,823
95 Strattera Atomoxetine $616,604,042
96 Viread Tenofovir Disoproxil Fumarate $599,074,197
97 Stribild Elvitegravir, Cobicistat, Emtricitabine, Tenofovir DF $598,844,153
98 Welchol Colesevelam $573,939,710
99 Combivent Respimat Ipratropium bromide and Albuterol $573,179,772
100 Xifaxan Rifaximin $569,762,570
Dr K K Aggarwal on Zee TV

cpr10 Mantra The CPR 10 Mantra is – "within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

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VIP’s on CPR 10 Mantra Video
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Ringtone – CPR 10 Mantra Hindi
Ringtone – CPR 10 Mantra English

Collective Consciousness

sprritual blog

Consciousness is an energized field of information with powers to do everything in the universe. Collective consciousness is the internet of the collective souls of many people in a group.

Collective consciousness is the strongest super power ever available in the universe. As per the Vedic texts, whatever is the intent of collective consciousness will become a reality. Scientifically, collective consciousness is based on the principle of critical mass. Vedic literature has shown it to be 1% of the defined population under study.

The origin of the critical mass comes from 100th monkey phenomenon. The story goes as under: long ago in Japan a monkey called Emo used to eat dirty apples everyday picked up from the ground. One day by accident the apple fell down in a river, the dirt got washed off and he ate the washed apple. Obviously it tasted delicious. He started washing the apples thereafter every day before eating. His fellow monkeys started following the same. The process of following went on. A time came when the 100th monkey washed the apple and ate it. A strange phenomenon was noticed. All monkeys in and around that state started washing the apple before eating. The no. 100 was the critical mass.

Once this mass is crossed the information will spread like a wild fire and the intent becomes a universal reality. Vedic literature has also shown if 1% of the public of any area meditates together the crime rate of that area goes down. It also talks about the role of critical mass in prayers in achieving miracles.

Thus principle of critical mass is often used in designing and organizing an event. In a movie hall of 1000 people if 10 people clap sitting in different areas everybody will clap. The same is true for hooting of a particular scene. Most politicians use this principle when they organize election rallies. For a gathering of 10000 they need 100 and for a gathering of 1000 people they only need 10 supporters who are suppose to sit in different areas and shout or clap on given directions. Mexican way of hooting or clapping in cricket grounds also follows the same principle. For a ground like Eden Gardens with a capacity of 75,000 people you only require 750 people to control the mood of the people. This is what happens in the recent incidence when the Indian team was hooted out by the sentence "No Ganguli no play, No Dada no play". If Greg Chappel or Jagmohan Dalmiya had anticipated this, they would have used the same strategy to produce just the opposite result. They could have posted 1500 people (2% of the population) in the stadium shouting pro–Dravid slogans and the end result of the match could have been different.

Most successful leaders used this technology to lead.

cardiology news

Two Monks and a Pretty Lady

Once upon a time a big monk and a little monk were traveling together. They came to the bank of a river and found the bridge was damaged. They had to wade across the river.

There was a pretty lady who was stuck at the damaged bridge and couldn’t cross the river.

The big monk offered to carry her across the river on his back to which the lady accepted.

The little monk was shocked by the move of the big monk and was thinking "How can big brother carry a lady when we are supposed to avoid all intimacy with females?" But he kept quiet.

The big monk carried the lady across the river and the small monk followed unhappily. When they crossed the river, the big monk let the lady down and they parted ways with her.

All along the way for several miles, the little monk was very unhappy with the act of the big monk. He was making up all kinds of accusations about big monk in his head. This got him madder and madder. But he still kept quiet. And the big monk had no inclination to explain his situation.

Finally, at a rest point many hours later, the little monk could not stand it any further; he burst out angrily at the big monk. "How can you claim yourself a devout monk, when you seize the first opportunity to touch a female, especially when she is very pretty?"

All your teachings to me make you a big hypocrite.

The big monk looked surprised and said, "I had put down the pretty lady at the river bank many hours ago, how come you are still carrying her along?"

Moral: This very old Chinese Zen story reflects the thinking of many people today. We encounter many unpleasant things in our life, they irritate us and they make us angry. But like the little monk, we are not willing to let them go away. There is no point in remaining hurt by the unpleasant event after it is over. Learn to move on in life!

News Around The Globe

  • A new study in the February issue of the American Journal of Infection Control shows that infection prevention and control programs in intensive care units vary widely in structure, organization, and adherence across the United States. Large differences were seen between hospitals in terms of prevention policies for central line-associated bloodstream infections, ventilator-associated pneumonia and catheter–associated urinary tract infections.
  • Healthcare providers can make choices in their attire that reduce the risk of spreading infection, according to guidance from the Society for Healthcare Epidemiology of America (SHEA) in Infect Control Hosp Epidemiol 2014;35:107–121. Dr. Gonzalo Bearman from Virginia Commonwealth University in Richmond said that ideally, HCW apparel should not come into contact with the patient at the point of care in the inpatient setting. This would include sleeves, watches, jewelry, and ties. Also, instruments such as stethoscopes should be wiped down after every patient encounter.
  • The European Commission has approved dimethyl fumarate (Tecfidera, Biogen Idec) as a first–line oral treatment in relapsing–remitting multiple sclerosis (MS), the company reported today. Dimethyl fumarate was approved in March 2013 by the US FDA, and has approvals as well in Canada and Australia.
  • Resistance training can increase the production of sex steroids in the muscles of older men, a new study shows. If borne out by further research, the findings could have important implications for a wide range of conditions experienced by many aging individuals and linked to a decline in sex steroid hormones, say Koji Sato, PhD, and colleagues from Ritsumeikan University in Kyoto, Japan in their report in the Journal of the Federation of American Societies for Experimental Biology published online January 17.
  • The National Institute of Mental Health and Neurosciences (NIMHANS) will conduct a national mental health survey this year and a pilot study will begin this month, Union minister of health and family welfare Ghulam Nabi Azad said, reported the Express News Service on February 6, 2014. The survey will be conducted across states and union territories. NIMHANS director Satish Chandra said the pilot phase of the national mental health survey would begin this month, while the survey will be completed by the end of the financial year.

CPR 10 success stories

1. Hands–only CPR 10 English

2. Hands–only CPR 10 (Hindi)

3. Ms Geetanjali, SD Public School Successful Story

4. Success story Ms Sudha Malik

5. BVN School girl Harshita does successful hands–only CPR 10

6. Elderly man saved by Anuja

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Rabies News (Dr. A K Gupta)

What is the "potency" of rabies vaccine?

WHO recommends that the vaccine potency should be at least 2.5 IU per dose. The potency is the capacity of the vaccine to induce immune response.

cardiology news

ABO Blood Type is a Risk Factor for Coronary Heart Disease

Two prospective cohort studies have identified the ABO blood group as a risk factor for the development of heart disease. People with blood groups A, B, or AB were 5–23% more likely to develop coronary heart disease compared with those with O blood type. The study by Dr Meian He from Harvard School of Public Health, Boston, MA included 62 073 women from the Nurses’ Health Study (NHS) and 27 428 men from the Health Professionals Follow–up Study (HPFS) and is published in the September 2012 issue of Arteriosclerosis, Thrombosis, and Vascular Biology.

In the NHS and HPFS, the incident rates of coronary heart disease per 100 000 person–years were 125, 128, 142, and 161 for women with type O, A, B, and AB, respectively, and 373, 382, 387, and 524 for men with type O, A, B, and AB, respectively. Compared with individuals with O blood type, individuals with blood group A, B, or AB had a respective 5%, 11%, and 23% increased risk of developing coronary heart disease in an age–adjusted model.

In non–O individuals, plasma levels of factor VIII–von Willebrand factor (vWF) are approximately 25% higher than in individuals with type O blood type. Elevated levels of factor VIII–vWF have been previously identified as a risk factor for coronary heart disease. The vWF has an important role in hemostasis and thrombosis by mediating platelet adhesion to the vascular wall, especially under high shear stress conditions

cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • A recent paper published in European Urology, the official journal of the European Association of Urology, indicates that the gonadotropin releasing hormone (GnRH) antagonist degarelix (brand name: FIRMAGON®), may halve the relative risk of cardiovascular (CV) events and death in men with pre-existing CV disease (CVD) compared to treatment with commonly prescribed luteinizing hormone-releasing hormone (LHRH) agonists. The report is based on a pooled analysis of 2,328 men with prostate cancer from six prospective, randomized trials.
cardiology news

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinewS)

  • Testing only one of a pair of twins to determine fetal lung maturity (FLM) is no guarantee that both are mature enough to be delivered. Donna Lambers, MD, of TriHealth Hospitals in Cincinnati, Ohio, and colleagues, reported here at the of the Society of Maternal–Fetal Medicine annual meeting that depending on the test used and the twin used as predictor, between 17% and 44% of co–twins would be incorrectly classified as mature.
cardiology news

Total CPR since 1st November 2012 – 86664 trained

Media advocacy through Web Media

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press release

The five Cs of five a day in selecting fruits and vegetables

The current recommendation is to eat 5 or more servings of fruits and vegetables daily to prevent cancer and heart disease. Fruits and vegetables contain vitamins, minerals, phytochemicals, and antioxidants and are low in calories. Those with the most color – dark green, red, yellow, and orange – have the most nutrients. Carrot, Celery, Cantaloupe, Cucumber and Corn are the five "Cs" which can be incorporated in the five a day diet. Ayurveda recommends that one should mix all seven colors and six tastes when choosing fruits and vegetables.

The USDA new Food Plate recommends filling half your plate with fruits and vegetables. Fruits, vegetables and grain products that contain fiber, particularly soluble fiber, may help reduce the risk of coronary heart disease. Fiber–containing grains, fruits and vegetables also reduce the risk of some cancers, said Padma Shri & Dr. B C Roy National Awardee, Dr. K K Aggarwal, President Heart Care Foundation of India and Senior National Vice President, Indian Medical Association.

A serving size is: one medium–size fruit, 1/2 cup raw or cooked fruits or vegetables, 180 ml fruit or vegetable juice, 1/2 cup cooked or canned legumes (beans and peas), 1 cup raw leafy vegetables, 1/4 cup dried fruit.

5 servings mean 2 fruits and 3 vegetables, 7 servings means 3 fruits, 4 vegetables and 9 servings means 4 fruits, 5 vegetables. Tips for safe eating

  • Snack with raw vegetables instead of potato chips.
  • Add fruits in your breakfast.
  • Eat at a salad bar when you go out for lunch
  • Prefer juice instead of a usual coffee, tea or soda.
  • Wash fruits and vegetables with water and scrub with a dish brush when appropriate.
  • Throw away the outer leaves of leafy vegetables, such as lettuce and cabbage.
  • Peel and cook when appropriate, although some nutrients and fiber may be lost when produce is peeled.
  • Avoid fruits and vegetables that look brownish, slimy or dried out. These are signs that the product has been held at an improper temperature
  • Wash cutting boards with hot water, soap and a scrub brush to remove food particles.
  • Wash hands with warm water and soap for at least 20 seconds before and after handling food, especially fresh whole fruits and vegetables and raw meat, poultry and fish. Clean under fingernails, too.

About HCFI : The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National Commemorative stamps and one cancellation stamp, and who has conducted one to one training on" Hands only CPR" of 86664 people since 1st November 2012.

The CPR 10 Mantra is – "Within 10 minutes of death, earlier the better; at least for the next 10 minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10×10 i.e. 100 per minute."

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CPR Training, Chinmaya Vidyalaya at Vasant Vihar, Delhi 4th February 2014

press release

Weight loss may improve sexual health of obese diabetes

vedio of day

today video of the dayPadma Shri & Dr B C Roy National Awardee, Dr KK Aggarwal on Tackling tension headaches

Hands only CPR 10 Utsav, 15th December 2013

Dr KK Aggarwal receives Harpal S Buttar Oration Award from Nobel Laureate Dr Ferid Murad

eMedi Quiz

A 60–year–old male presented to the emergency with breathlessness, facial swelling and dilated veins on the chest wall. The most common cause is:

1. Thymoma
2. Lung cancer.
3. Hodgkin’s lymphoma.
4. Superior vena caval obstruction.

Yesterday’s Mind Teaser: All of the following regarding aromatase inhibitors (AIs) are correct except:

1. Unlike tamoxifen, AIs are associated with an increased risk of endometrial cancer.
2. AIs have been shown to reduce bone density, and increase the risk of fractures.
3. Aromatase inhibitors are not indicated in premenopausal women.
4. The musculoskeletal symptoms associated with the AIs are transient.

Answer for yesterday’s Mind Teaser: 1. Unlike tamoxifen, AIs are associated with an increased risk of endometrial cancer.

Correct answers received from: Dr.Bitaan Sen & Dr.Jayashree Sen, DR.A.K.GAJJAR, Dr Jainendra Upadhyay, Dr. P C Das, Dr,Raghavendra Jayesh, Dr.K.Raju, Tukaram Pagad

Answer for 9th February Mind Teaser: C. About 30 percent of your daily calories.

Correct answers received from: Dr.K.V.Sarma, Dr Chandresh Jardosh, DR AVTAR KRISHAN, Muthumperumal Thirumalpillai

Send your answer to ijcp12@gmail.com

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medicolegal update

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medicolegal update
medicolegal update

That’s Not It

A general noticed one of his soldiers behaving oddly. The soldier would pick up any piece of paper he found, frown and say, "That’s not it" and put it down again.

This went on for some time, until the general arranged to have the soldier psychologically tested. The psychologist concluded that the soldier was deranged, and wrote out his discharge from the army.

The soldier picked it up, smiled and said, "That’s it."

medicolegal update

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medicolegal update

Situation: An elderly patient with unstable angina presented with URTI and was found to be positive for Chlamydia pneumoniae infection.
Reaction: Start macrolides immediately.
Lesson: Make sure to remember that erythromycin 2 g/day for 10–14 days reverses the increased risk of atherosclerosis.

medicolegal update

It costs nothing to dream, but everything if you don’t. Rita Davenport

medicolegal update

Dr KK Aggarwal: Weight gain precedes the onset of diabetes Weight gain after age of 18 years in women and 20 years in men (cont) http://bit.ly/15QdVeB #Health
Dr Deepak Chopra: If we share with caring, lightheartedness, and love, we will create abundance and joy for each other http://bit.ly/DC_Ananda #ananda

Forthcoming events

Date: Saturday 2PM-Sunday 3PM, 26–27 April 2014
Venue: Om Shanti Retreat Centre, Bhora Kalan, Pataudi Road, Manesar
Course Directors: Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal and BK Sapna
Organisers: Heart Care Foundation of India. Prajapati Brahma Kumari Ishwariye Vidyalaya and eMedinews
Facilities: Lodging and boarding provided (one room per family or one room for two persons). Limited rooms for first three hundred registrants.
Course: Meditation, Lectures, Practical workshops
Atmosphere: Silence, Nature, Pyramid Meditation, Night Walk
Registration: SMS– Vandana Rawat – 9958771177, rawat.vandana89@gmail.com
SMS – BK Sapna 9650692204, bksapna@hotmail.com

Note: Donation in Favor of Om Shanti Retreat Centre will be welcomed

medicolegal update
  1. Dr K.K. your Medinews is a precious weath! warm Regards jagat Rana

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